Provider Demographics
NPI:1750331070
Name:PADALA, PRASAD RAO KD (MD)
Entity Type:Individual
Prefix:
First Name:PRASAD RAO
Middle Name:KD
Last Name:PADALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:3J/NLR
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-2503
Mailing Address - Fax:501-257-2501
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:3J/NLR
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-2503
Practice Address - Fax:501-257-2501
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE223292084P0800X
ARE-72692084P0800X, 2084P0805X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557539Medicaid
NE277706Medicare ID - Type Unspecified
NE47078557539Medicaid